Form is Free

EKO EKO ELECTRICITY DISTRIBUTION COMPANY

DISTRICT……………….APPLICATION NO…………..

APPLICATION FOR ELECTRICITY SUPPLY AND 2 Recent Passport

AGREEMENT FORM Photograph of the
(TO BE COMPLETED IN DUPLICATE BY THE APPLICANT AFTER STUDYING Applicant
THE CONDITIONS AND REGULATIONS OF SUPPLY SPECIFIED OVERLEAF)
(With Name and
PART 1: CUSTOMER PERSONAL DATA-LANDLORD (OWNER OF PREMISES) Signature behind)

1.1 NAME OF ACCOUNT

SURNAME: (MR/MRS/MISS/CHIEF) ………………………………………………………………………………………………………………….……………………………..
OTHER NAMES IN FULL ………………………………………………………………………………………………………………………………………………………………..….

1.2 DATE OF BIRTH……………………………………………………….

1.3 CONTACT TEL NO……………………………………………………

1.4 EMAIL ADDRESS…………………………………………………….

1.5 NAME AND ADDRESS OF EMPLOYER OR BUSINESS…………………………………………………………………………………………………………………………….

1.6 METER NUMBER (Where Applicable) …………………………………………………………………………………………………………………………………………………….

1.7 CUSTOMER ACCOUNT NUMBER (FOR PREMISES) ………………………………………………………………………………………………………………………………..

1.8 VALID MEANS OF IDENTIFICATION: International Passport Driver’s License National ID Card PVC
(Please tick applicable one)

1.9 PERSONAL IDENTIFICATION NUMBER (International Passport, Driver’s License, National ID Card, PVC) ………………………….………………...
1.10 ADDRESS AT WHICH SUPPLY IS REQUIRED…………………………………………………….……………………………………………………………………………………..
…………………………………………………………………………………………. HOUSE NO………………………………………………………………………………………………..
BUS STOP……………………………….……………………………………………LANDMARK……………………………LGA…………………

Signature……………………………………………………………………………………..Date…………………………………………………………………………………………………………….

1.11 TYPES OF PREMISES (BUILDING)

2BD Room Flat
Tenement House
3BD Room Flat
Single Room
Shop/Boys Qtrs.
Block of Flats
Duplex
Others (Please Specify) ………………………………………………………..

1.12 USE OF THE PREMISES……………………………………………………………………………………………

• Residential
• Commercial
• Special
• Industrial

PREVIOUS
(A) CUSTOMER ADDRESS ……………………………………………………………………………………………………………………………………………..
(B) ACCOUNT NUMBER……………………………………………………. METER NUMBER………………………………………………………………..

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1.13 TO BE FILLED IF OCCUPIER IS DIFFERENT FROM APPLICANT
NAME AND ADDRESS OF OCCUPIER OF THE PREMISES……………………………………………………………………………………………………................
……………………………………………………………………………………………….………………………………………………………………………………………………………
……….......................................................................................................................................................................................................
CONTACT TEL NO(s) ……………………………………………………………………………………….

VALID MEANS OF IDENTIFICATION: International Passport Driver’s License National ID Card PVC
(Please tick applicable one)

PERSONAL IDENTIFICATION NUMBER: …………………………………………………………………..

1.14 NAME AND ADDRESS OF EMPLOYER/BUSINESS………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………………………………………………………………..
1.15 CONTACT TEL No(s)………………………………………………………………………………………………………………………………………………………………………….
1.16 E-MAIL ………………………………………………………………………………………………………………………………………………………………………………….…………

PART 2: DECLARATION (TO BE COMPLETED BY CERTIFIED/REGISTERED ELECTRICAL ENGINEER/ACCREDITED

ELECTRICAL CONTRACTOR)
2.1 LOAD REQUIREMENT FOR THE PREMISES

No Wattage No. Total H.P

A. Lighting Points
Ceilings fans
B.
Socket Outlets - 5 Amps
C. - 13 Amps
- 15 Amps
D. Cooker
E. Water-Heater
F. Air-conditioner
G. Others

*Details of Additional Equipment can be attached separately. Total installed load…………………………………………..

Watts

2.2 NATURE OF PROPERTY: OLD OR NEW

2.3 TYPE OF PROPERTY: SINGLE HOUSE APARTMENT TERRACE PUMP HOUSE

OTHERS (Please explain) ………………………………………………………………………………………………………………………………………………………………

2.4 DOES THE PROPERTY HAVE PLANNING PERMISSION: YES NO

2.5 DOES THE PROPERTY HAVE A METER: YES NO

2.5.1 IF PROPERTY HAS A METER

2.5.2 METER NUMBER …………………………………………………………………………………………………………………………………………………………………………….

2.5.3 CUSTOMER ACOUNT NUMBER ………………………………………………………………………………………………………………………………………………………

2.5.4 METER TYPE AT PROPERTY: PRE-PAYMENT OR POST-PAID METER OR MAXIMUM DEMAND

2.6 ESTIMATED MAXIMUM LOAD FOR …………………………………………………………………………………………. Amperes per phase

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2.7 REQUESTED VOLTAGE/TYPE OF SUPPLY ………………………………………………………………………………………………………………………………………….

2.8 NAME OF THE REGISTERED ELECTRICAL ENGINEER/ELECTRICAL CONTRACTOR

ADDRESS…………………………………………………………………………………………………………………………………………………………………………………………
LICENSE NO …………………………………………………………………………… CATEGORY……………………………………………………………………………………..
SIGNATURE…………………………………………………………………………………. DATE…………………………………………………………..…………………………….

2.9 TO BE COMPLETED BY ONLY THOSE REQUESTING FOR CHANGE OF CUSTOMER CLASS

METER NUMBER…………………………………………………………………. ACCOUNT NUMBER…………………………………………………………………………

2.10 I/WE HEREBY REQUEST EKO ELETRICITY DISTRIBUTION PLC TO SUPPLY US WITH ELECTRICITY AT THE ADDRESS STATED AT THE 1.10
ABOVE FOR THE PURPOSE STATED IN 1.12 ABOVE AND AGREE TO PAY ALL CHARGES MADE BY EKO ELECTRICITY DISTRIBUTION PLC
IN ACCORDANCE WITH THE PREVAILING EKO ELECTRICITY DISTRIBUTION PLC TARRIF SUPPLY AS APPROVED BY NIGERIAN
ELECTRICITY REGULATORY COMMISSION (NERC)

2.11 I/WE CONFIRM THAT THE INFORMATION GIVEN IN PART 1 ABOVE IS TRUE IN ITS ENTIRETY AND AGREE THAT IF ANY PART OF IT IS
FOUND TO BE UNTRUE, THE ELECTRICITY SUPPLY MAY BE DISCONTINUED.

APPLICANT’S SIGNATURE…………………………………………………………………… DATE ……………………………………………..……………………………………………….

PART 3: FOR OFFICIAL USE ONLY

TYPE OF APPLICATION TICK

i. NEW SERVICE
ii. ADDITIONAL LOAD/REPRODUCTION
iii. CHANGE OF CUSTOMER
iv. ADDITIONAL METER
v. CHANGE OF TARIFF
vi. CONVERSION FROM SINGLE PHASE TO THREE PHASE
TO MD METER
vii. IS PROPERTY EARTHED?
viii. PLANNING PERMISSION (NEW PROPERTY)

3.1 CUSTOMERS REFERENCE / PREFERRED METHOD OF PAYMENT

BY MANAGER’S CHEQUE { } BY ATM { } BY POS { } ONLINE { } CASH DEPOSIT { }

Please tick preferred method(s)

3.2 PREFERRED METHOD OF RECEIVING BILLS IN ADDITION TO DELIVERY TO THE HOUSE

(a) BILLS SENT BY SMS { } or BILLS SENT BY EMAIL { }

3.3 CUSTOMER IDENTIFICATION NO (CIN) …………………………………………………………………………………………………………………………

3.4 GPS COORDINATE…………………………………………………………………………………………………………………………………………………………

3.5 DISTRIBUTION TRANSFORMER………………………..……………………. 3.6 FEEDER………………………………………………………..

REMARK/RECOMMENDATION……………………………………………………………………………………………………………………………………………………

THE ORIGINAL OF THIS APPLICATION HAS BEEN RECEIVED BY ME

NAME…………………………………………………………………………………………DESTINATION……………………………………………………………………….

SIGNATURE…………………………………………………………………………………DATE…………………………………………………………………………………….

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(B) TO BE COMPLETED BY METER SUPERVISOR

METER NO…………………………………………………………………..ACCOUNT NO………………………………………………………….……………….

METER READING ON THE LAST BILL……………………………………………………………………………………………………………………………….
FINAL METER READING ON…………………………………………………………IS………………………………………………………………………………
(DATE)

SIGNATURE…………………………………………………………………. DATE………………………………………………………………………………………
NAME ………………………………………………………………………….. DESIGNATION……………………………………………………………………….

(C) TO BE COMPLETED BY CREDIT CONTROL SECTION

THE LATEST BILL ON THE ACCOUNT IS: ……………………………………….. (MONTH) …………………………….. (AMOUNT).

THE OUSTANDING IS ₦………………….. FINAL BILL AS PER PART (B) ABOVE IS ₦…………………………
THE TOTAL NOW DUE OF ₦…………………….. FINAL VIDE EKO ELECTRICITY DISTRIBUTION PLC MACHINE RECEIPT
NO……………………….
(I) WAS SETTLED ON ………… FINAL VIDE EKO ELECTRICITY DISTRIBUTION PLC MACHINE RECEIPT NO……………..
(DATE)
OF……………………………………………………..
(DATE)

(II) ₦………………….. HAS NOT BEEN SETTLED BUT TRANSFERRED TO ACCOUNT OF ……………………. OF ………………….…
ACCOUNT NO…………………………………………………..……. METER NO………………………….…………………………………………..
NAME……………………………..……………..…………………………………………………………………………………………………………………
ADDRESS…………………………………………………………………………………………………………………………………………………………..

THE APPLICATION IS HEREBY CLEARED FOR FURTHER PROCESSING

SIGNATURE…………………………………………………………………………. DATE……………………………………………………………………………………………
NAME…………………………………………………………………………………. DESIGNATION………………………………………………………………………………

(D) FINAL APPROVAL

CHECKED BY:
NAME………………………………………………………………. DESIGNATION……………………………………………… DATE………………………………………

APPROVED BY:
NAME………………………………………………………………. DESIGNATION……………………………………………… DATE……………………………………….

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PART 4: CONDITIONS AND REGULATIONS OF SUPPLY

I/We …………………………………………………………… hereby request that Electricity be supplied in accordance with the
Electricity Power Sector Reform Act 2005 of the Federal Government of Nigeria and all the relevant Codes and
Regulations as approved by the Nigerian Electricity Regulatory Commission (NERC).

Eko Electricity Distribution Plc (thereinafter called “EKEDP”) will supply Electricity subject to the following conditions.

1. SYSTEM OF SUPPLY
EKEDP system is Alternating Current at a frequency of 50 Hertz. The medium voltage supply will be either 230 Volts
single phase or 400 Volts three phase.

2. INSTALLATIONS
Wiring Installation shall be executed to the satisfaction of EKEDP which will inspect and/or test the installation.

3. SERVICE LINE
The nature and location of service lines and other supply facilities shall be determined by EKEDP. EKEDP shall be at
liberty at any time to take branch services off the service lines whether on the customer’s premises or not, for the
purposes of supplying electricity to any other premises. The customer shall obtain all facilities required by EKEDP for all
installation of the service line including the necessary Right of Way over his own and/or adjacent property which EKEDP
may require. Any service line or other facilities provided by or donated by a customer shall be treated in line with the
Investment in Networks Regulation by the Commission.

4. ACCESS TO PREMISES
The Customer shall give EKEDP all reasonable and necessary access to the customer’s premises for the purpose of
connecting, disconnecting, inspecting, testing, altering, replacing, maintaining or removing any service line, meter
and/or other apparatus or any part thereto and for reading meter. EKEDP official will produce EKEDP official identity
card, upon demand. The Customer shall pay a fee for each special meter reading made on request.

5. ADDITIONAL EQUIPMENT
After the installation referred to in schedule 2.1 hereof has been tested and passed by EKEDP, the customer shall not
have any additional equipment connected to his installation without submitting an application form EKEDP 74 to EKEDP,
giving at least seven days’ notice of his intention to do so and he shall not use additional equipment until the installation
has been re-tested and passed by EKEDP. Neglect of this precaution may cause interruption of supply and damage to
EKEDP Equipment; hence, a penalty may be imposed for default.

6. TESTING AND ACCURACY OF METERS

Should the customer or EKEDP give notice disputing the accuracy of a meter, such meter shall be tested by the Nigerian
Electricity Management Services Agency (NEMSA). If the Customer considers his meter inaccurate, his notice to that
effect shall be accompanied by a deposit to cover the cost of the test. In the event of the meter having an error exceeding
the line of error as may be allowed by the regulation in force, the amount payable for electricity charge for the period
for which the customer is charged on the last invoice rendered prior to the notice of dispute shall be determined in line
with the provisions of NERC’s Regulation on Meter Reading, Billing, Cash Collection and Credit Management.

7. DISCONTINUANCE OF SUPPLY
Not less than seven clear days’ notice in writing shall be given to EKEDP by the Customer before transferring ownership
of the premises. In default of such notice Customer shall be liable to EKEDP for all accounts arising until such notice is
received or until EKEDP accepts an application for the supply to the same installation from another Customer. EKEDP
reserves the right to discontinue supply of electricity for safety, when other Customers are being connected or when
EKEDP’s mains or equipment are being tested, repaired, on in cases of unavoidable interruption due to fire, flood,
tempest, accidents and break-down of machinery.

8. PAYMENT FOR ELECTRICITY SUPPLY

From the date supply is made available, the Customer must pay monthly for all electricity billed in accordance with the
applicable rate. Official Receipts are issued by EKEDP for all payment made to it. Customers are advised on each occasion
to check that the amount on their receipt corresponds with the sum paid.

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9. RESPONSIBILITY FOR EKEDP APPARATUS
The Customer shall ensure the safety against damage or destruction by fire and shall be solely responsible for the safe
custody of the meter and other apparatus belonging to EKEDP that were installed at his premises, and shall not
damage, alter, remove the same, or obliterate or remove any such marks, words or numbers thereon, or permit any
such damage. The Customer shall make good any such damage or reimburse EKEDP to the extent of any loss EKEDP
may sustain by reason of any breach of these conditions and regulations. The Customer shall give notice to EKEDP of
any break-down, failure, loss, injury or damage to the meter of any apparatus belonging to EKEDP installed in his
premises.

10. NON-LIABILITY OF EKEDP

EKEDP will not be responsible for any loss or damage occasioned to any person or property, whether belonging to the
Customer or not, arising out of any defects in or accident to the wiring installation or by the use of the electricity
supplied or any apparatus that belongs to EKEDP or through any fault arising on EKEDP system or for any cause beyond
their control. This provision is subject to EKEDP putting in place all reasonable safety measures to ensure a duty of care
in the discharge of its responsibility to the Customer.

11. THE IMPROPER USE OF SUPPLY

If the Customer shall make use of the supply in such a way as to interfere with the general distribution of the electricity,
immediate steps shall be taken to remedy the defects complained of or supply discontinued.

12. BREACH OF AGREEMENT

If the Customer shall neglect or refuse to pay for the electricity supplied in accordance with these conditions and
regulations, or become subject under the bankruptcy laws or enter into liquidation or suffer execution to be made on
his effects or commit any other breach of this agreement, EKEDP may terminate this agreement and/or discontinue
the supply of electricity and/or remove the apparatus belonging to them subject to the provisions of NERC’s Regulation
on Connection and Reconnection of Electricity Services.

13. REVISION OF CONDITIONS OF SUPPLY.

EKEDP may from time to time, on giving notice to the Customer in writing or by public notice amend or alter any of
the above conditions supply or their scale of charges and such amendment or alterations shall take effect as from the
date specified in the said notice as approved by NERC.

14. The customer and EKEDP also hereby agree to abide by and exhaust all administrative remedies as contained in the
NERC Customer Complaint Handling and Procedures Regulations before resorting to any other dispute resolution or
adjudicatory process.

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CUSTOMER’S FURTHER UNDERTAKING

This Declaration/Undertaking is executed on this _____ day of ______ 20___ by _____________________ of

______________________hereinafter referred to as the Applicant which unless the context otherwise provides includes his/her
respective heirs, legal representatives, successors and assigns and the applicants hereby undertake and declares as under

OR…

________________________________________, a company duly incorporated under the laws of Federal Republic of Nigeria with
registration number ______, having its principal place of business at
____________________________________________________________(hereinafter referred to as Applicant which unless the context
otherwise provides includes its successors and assigns, and the Applicant hereby undertakes and declares as hereunder

OR

_________________________, a sole proprietor/a partnership firm having its office at _______________________________

hereinafter referred to as the Applicants which unless the context otherwise provides includes its successors and assigns, through
Mr./Mrs./Ms. ________________________ who is a partner or an authorized representative hereby undertakes and declares as
hereunder:…………………………………………

1. That the Applicant came into the possession of the said premises vide a Certificate of Occupancy /Deed of Assignment/Deed of Gift
dated ………………………………….

2. That the Applicant is the owner of the …………………………………………………… (Description of

property)……………………………………………………………at……………………………………………... (address) which falls under EKEDP’s distribution
area for supply of electricity.

3. That the Applicant has applied to EKEDP for grant of a new electricity connection and to be recognized as the registered consumer in
respect of the said connection at the said premises vide request no…………………………………, for a load of ………………….KW/h. The
Applicant undertakes to supply all such documents as may be required by EKEDP in that regard and to fulfill all prescribed formalities.

4. That if the new connection requested by the Applicant is granted, the Applicant undertakes to provide any, all such documents to
EKEDP as may be required by them from time to time as proof of ownership of the property including title and identification
documents, electrical drawings etc.

5. The Applicant unconditionally undertakes to keep EKEDP/its officers indemnified against any
losses/damages/risks/liabilities/claims/prosecutions/fines/levies/compensation/proceedings which EKEDP may be subject or be
made liable for or made to suffer as a result of grant/release of the new electricity connection to the Applicant on the basis of this
undertaking including any legal or other expenses reasonably incurred by EKEDP in defending itself/its officers as well as for the
cost/compensation(s) to which EKEDP may be subject to, under any law or pursuant to directions of any court/tribunal/authority as
a result of failure to comply with the terms/conditions of the FORM 74, act of forgery, any material concealment of information, as
well as those of any other relevant documents required to be executed by the Applicant or attributable to false/wrong information
furnished by the Applicant in respect thereto. This indemnification shall be without prejudice to EKEDP’s right to disconnection of
electricity at the relevant premises and initiation of appropriate legal proceedings.

6. That In the event of an estimated bill, the Applicant shall promptly pay all charges stated in the relevant bill.

7. That EKEDP may also demand such amounts of additional Security deposit from the Applicant from time to time as EKED PLC may
deem fit as a safeguard for securing any event of non-payment on behalf of the Applicant.

8. That EKEDP has a right of set off and may without prejudice to its other rights, transfer payments and receivables from the old
connection towards the new connection and vice versa.

9. That the Applicant shall use electricity only for the purposes for which it has been sanctioned by EKEDP and shall in no way be misused
for any other purpose(s).

10. That the Applicant shall not extend/sublet this electricity supply to any other premises without prior written consent of EKEDP.

11. That in the event the premises is leased to any person or entity, the Applicant shall notify EKEDP and supply all relevant details about
the tenant or lessee and the Applicant shall notify EKEDP of any change in tenant(s) or lessee(s) and update their records accordingly.

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12. That the Applicant’s industry/trade has not been declared to be obnoxious, hazardous/pollutant by any Government agency and that
no court orders are being infringed by grant of applied electricity connection at the premises. In case at a later date it is found
otherwise, then the Applicant agrees that electricity supply should immediately be disconnected by EKEDP without any
reference/notice to the Applicant.

13. That the Applicant would allow clear and unencumbered access to authorized officials of EKEDP to the premises for the purposes of
meter reading, maintenance, inspection, checking, testing, prepaid meter monitoring etc.

14. That EKEDP shall be entitled to disconnect the electricity in the Applicant’s premises in the event of any default and/or non-
compliance of statutory requirements and/or in consequence of an order by statutory authority/Court of Law.

15. That all details furnished in the Form 74 are true to the Applicant’s knowledge. If any information is found incorrect at a later date,
then EKEDP will have the right to withhold/disconnect power supply to the Applicant’s premises.

16. In the event of this connection being given, this Undertaking together with the Form 74 shall be treated as an agreement for the
connection with effect from the date the connection is given till such time as it is replaced by a fresh agreement or this agreement is
terminated.

Signed and delivered by Applicant:

___________________________

In the presence of:

Name: ………………………………………………………………………………………………………………………………………………………………………………

Address: …………………………………………………………………………………………………………………………………………………………………………..

Signature: ………………………………………………………………………………………………………………………………………………………..……………….

Date: ………………………………………………………………………………………………………………………………………………………………...………………

ACKNOWLEDGEMENT SLIP

APPLICATION NUMBER…………………………………………………………………………DATE……………………………………………...

CUSTOMER’S SIGNATURE………………………… EKEDP REPRESENTATIVE’S SIGNATURE………………………………………

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